P53 REAL-WORLD TREATMENT SEQUENCES AND COSTS OF 96 PATIENTS WITH MULTIPLE MYELOMA FROM DIAGNOSIS TO DEATH
Authors: M.R. Seefat, D.G.J. Cucchi, K. Groen, M.L. Donker, K.G. van der Hem, M. Westerman, A.M. Gerrits, A. Beeker, N. van de Donk, H.M. Blommestein, S. Zweegman
Journal: HemaSphere (2023)

Introduction: The development of treatment options for multiple myeloma (MM) has improved survival, but also come with increased treatment costs, which can pose a burden on health care funding and limit access to drugs. Therefore, costs and cost-effectiveness analyses are increasingly important in medical decision making. Such analyses are often based on average health outcomes and costs over a lifetime perspective. However, specifically the end of life (EOL) phase is accompanied by high health care costs, while the contribution of active drug treatment to survival time and quality of life might be minimal. Therefore, we investigated the drug costs from diagnosis to death in detail, in a real-world cohort of MM patients. Methods: We analysed health care records from all MM patients who received (a part of) their treatment in Amsterdam University Medical Centre, and who died between January 1st 2017 and July 1st 2019. We extracted all anti-MM treatments from diagnosis to death, including dose adjustments and start- and stop dates. We calculated drug costs using the Dutch Z-index (indicating drug costs), of August 2020. Results: 96 patients were eligible for analysis and received a median of 5 (range: 1-16) lines of therapy; 61 (63.5%) received a stem cell transplantation (SCT). Time to next treatment or death from 1st to 2nd line of therapy was longer in patients who received an SCT (median 23.9 vs 13.0 months, p=0.002) and was progressively shorter at later lines of therapy, without significant differences between patients who did or did not receive an SCT. Mean total drug costs of MM treatments (from diagnosis to death) were €211,563 (range: €3,942 - €776,185; €3,139 per month [range: €54 – €8,309]). Eighty-two patients (85.4%) received anti-MM treatment in the last 3 months before death and the mean drug costs in this period were €20,361 (range: €70 - €50,466; 9.6% of total). Forty-nine (51.0%) patients received anti-MM treatment in the last 14 days before death and 33 (34.4%) in the last seven days. Mean drug costs per month were approximately twice as high as compared to costs per month over the myeloma life time. (approximately €6,700 versus €3,139 per month), Table 1. Conclusion: The majority of patients received anti-MM therapy during the 14 days preceding death. Associated drug costs were considerable, especially in light of limited survival benefit. Moreover, this is expected to increase as the novel drugs that are currently available also been given at later lines are more expensive. In view of the increasing budget impact of anti-myeloma treatment, hampering access to novel drugs, and the possible negative impact of EOL treatment on QoL, the identification of factors predicting efficacy and clinical benefit of continuing EOL therapy, warrant further investigation. Table 1 - Numbers of patients and (relative) costs of treatment per period. Period Patients receiving treatment (% of total) Mean costs of treatment (range; % of total costs) Mean relative costs per month (range)* Diagnosis to death 96 (100) €211,563 (€3,942 - €776,185; 100) €3,139** (€54 – €8,309) - With SCT - 61 (63.5) - €210,863 (€17,317 - €621,756) - €2,921** (€87 - €8,309) - Without SCT - 35 (36.5) - €212,784 (€3,942 - €776,185) - €3,607** (€54 - €8,072) Last 3 months 82 (85.4) €20,361 (€70 - €50,466; 9.6) €6,787 (€23 - €16,822) Last 30 days 66 (68.8) €6,188 (€10 - €17,444; 2.9) €6,271 (€10 - €17,677) Last 14 days 49 (51.0) €3,001 (€9 - €9,512; 1.4) €6,516 (€20 - €20,655) Last 7 days 33 (34.4) €1,662 (€3 - €4,757; 0.8) €7,218 (€13 - €20,659) (*) 30.4 days(**) mean total costs divided by mean OS per groupAbbreviation: SCT = Stem cell transplantation